Fleury SA

BOVESPA:FLRY3

Earnings Call Analysis

Robust Revenue Growth and Expanding Market Share Amid Seasonality

Grupo Fleury showcased formidable revenue growth in 2023, with gross revenues hitting BRL 7 billion, marking a 44.9% increase compared to the previous year. Pro forma gross revenue enjoyed a steady climb of 5.1% year-over-year to BRL 1.8 billion, with organic growth accounting for 4.7%. Notably, the company witnessed significant growth in its Home Services and New Links segments, at 10.9% and 17.1% respectively. Yet, the fourth quarter faced challenges from seasonality, particularly impacting the premium Fleury brand due to holiday effects, a trend seen across the retail market.

Advancements in Operational Efficiency and Elevated Profitability

Operational efficiency gained momentum with PSC gross revenues achieving a 32.4% jump to BRL 1.2 billion in the fourth quarter, reflecting strong performance across all regional segments. EBITDA and net income for the year were particularly impressive, with EBITDA surging 61.5% to BRL 375.8 million in this quarter, culminating in a full-year growth of 39.2%. Looking at net income, the company registered a staggering 162.3% increase quarter over quarter and ended the year with a robust 62% growth in net income at BRL 498.9 million, excluding certain business combination expenses.

Strategic M&As and Organic Expansion Driving Forward

Grupo Fleury emphasized financial discipline in its M&A activities and organic growth strategies. The acquisition of the Pardini Group, for instance, has positioned the company as a leader in Brazilian healthcare, bolstering its operational credentials. Despite its disciplined approach, the company expressed optimism around both inorganic and organic avenues contributing to future growth, with a steady hand on maintaining a sound financial position and controlling costs effectively.

Winning Synergies from the Integration of Pardini

The amalgamation with the Pardini Group is marching forward as planned, with synergies expected to bring in BRL 200 million to BRL 230 million over 3 years. The collaboration between the two entities is enhancing logistical efficiencies and expanding the lab-to-lab exam offerings. Grupo Fleury has remained vigilant about cultural integration and people management to ensure the success of this strategic union.

Investment in Innovation Defending Competitive Edge

The company continues to reinforce its commitment to science, technology, and innovation with the launch of 500 new products. Investments in technology have significantly improved productivity and customer experience, particularly in diagnostic medicine where AI applications have yielded up to 48% higher processing capacity in magnetic resonance imaging.

Navigating a Complex Healthcare Ecosystem with Diverse Market Strategies

Grupo Fleury is steering through the healthcare market with varied brand offerings from premium to intermediate services. The company is adapting to the changes in the healthcare plans landscape and is strategizing to expand its total addressable market through strategic contracts and penetration of mobile services.

Financial Discipline and Leverage Management

While the company abstains from giving detailed financial guidance, the management conveyed a clear commitment to managing working capital and leverage judiciously. The goal is to invest carefully, prioritizing a balance between accounts receivable and payable without pressuring working capital, thus safeguarding the company's financial health and allowing for sustained expansion.

Earnings Call Transcript 2023-Q4

[Operator]

Good morning, everybody, and I would like to welcome you to the conference call for the Grupo Fleury fourth quarter 2023. Today, we have with us Jeane Tsutsui, the company, CEO; Mr. Filippo the Executive Finance Director; and Mr. Renato Braun, the IR Director. I would like to inform you that this event is being recorded and we have simultaneous translation into English.

First of all, we will be presenting the company results. And ensuing this, we will go on to the question-and-answer session. At the end of the session, Ms. Jeane Tsutsui will go on to the closing remarks. All the figures mentioned here are compared to the same period of 2022, except when otherwise specified. They have been rounded to the closest figures.

Now this presentation may contain information about future events. Such information is not near historical facts, but reflects the wishes and expectations of the company's management. The words believe, expect, plan, anticipate, estimate, project, aim and the like are intended to identify statements that necessarily involve known and unknown risks. Known risks include uncertainties which are not limited to the impact of price and service competitiveness, market acceptance of services, company and competitor service transactions, regulatory approval, currency fluctuations, changes in the mix of services offered and other risks described in the company's reports.

I would now like to turn the floor over to Ms. Jeane Tsutsui.

[Jeane Tsutsui, executive]

Good morning, everybody, and I thank you for your attendance at this earnings results call for Grupo Fleury for the fourth quarter. In our agenda today, we will begin with a general overview of Fleury and avenues for growth. We will then speak about ESG highlights and then the financial highlights, as you have been accompanying in our shared slides.

Slide 5 shows you the strategic view of group of Grupo Fleury. We are strengthening our strategic brands. After the incorporation with Pardini Group, we have more than 500 units in several states working with the basic, intermediate and premium group. We have reinforced the diagnostic medicine with laboratories throughout the country. We also have experienced health professionals that represent more than 22,400 employees and 4,900 physicians. We are offering preventive and ambulatory medicine for [indiscernible] diseases.

And this is crucial for the health system besides diagnostic medicine that offers support at all stages of care, offering treatment. We also act on primary care with vaccination, check-up and clinical consultations and secondary attention with medical care and low complexity tertiary care. With this, we are present in all of the stages of the patient's journey.

Slide 6 shows you the avenues for growth. We have a broad portfolio of clinical services and [indiscernible] our PSCs and a good relationship with physicians and operators. Diagnostic medicine represented 67% of the group, B2B lab-to-bed medicine represents services throughout the country. There is an expansion of the addressable market and higher logistic efficiency.

It represented 24% of the group's revenue. We have new links that go from consultations to treatment in specialized areas and that allows us to increase the integration of the patient's journey. This represents 8% of the group's revenue. The fourth avenue are the health platforms with partnership laboratories, and this represents 1% of the group's total revenue.

In #7, I would like to highlight our ESG actions. We believe that responsible practices bring about tangible reports, greater competitiveness, a better risk management, and we have the valuable opportunity of combining innovation and new businesses. And this leads to a positive social impact.

We would like to be an ESG benchmark in the market incentivating sustainable practices in other companies. We do want to lead the innovative innovation of the health group, foster more knowledge to qualify the market and democratize access to health.

In Slide #8, you see our commitments regarding ESG. In the environmental area, we have begun working on net zero until 2050. We will be reducing 20% of biological waste by 2025. We have invested in photovoltaic plants for 21% of total consumption with a 24% cost reduction and a reduction of 4,500 metric tons of CO2. Through brands and initiative focused on lead, we would like to attain 1 million customers serviced until 2026.

And we're working with commitment with sustainable development. We have also expanded the diversity in the organization through training and affinity groups that include generational gender female leadership, ethnic, racial and LGBTQIA+. We are accelerating leadership position for black females. And of course, we combat all forms of violence.

In governance, we are in the new B3 market.

We discussed several committees working with finances, audits, risk and integrity, strategy and technology, culture and people besides the ESG. We also reinforce our commitment with integrity. We are part of Brazil Global Compact Network, which means we are aligned with the best governance practices and social responsibility.

Our efforts in that direction have had significant results. In 2023, we were part, for the 11th consecutive time, of the ISEB3. And for the fourth consecutive time, we were part of the Dow Jones Sustainability Indexes. Before we present the financial highlights for 2023, besides the accounting results, we present the same basis for the periods that will help you to better understand the results.

As you see in Slide 10, the accounting result captures the results of Hermes Pardini and the Grupo Fleury. The pro forma result is for a simple comparison and it compares 3 months for the quarter and the 12 months of Fleury and Instituto Hermes Pardini as if both operations were combined in the same period of 2022 and 2023.

We have the accounting highlights for the fourth quarter '23. And you will see that the combination of business has elevated the company to a new revenue level. Gross revenue reached BRL 1.8 billion, 53.1% growth vis-a-vis 2022. In Ex COVID, the growth was 54.3%, a growth of 4.6% of the Fleury brand, 46.3% of other brands in Sao Paulo, Home service 21.7% and New Links with 12% of organic growth.

EBITDA was BRL 375.8 million with a margin of 22.1%, 9% higher than the same period last year. Net income totaled BRL 81.3 million with a 4.8% margin. In 2023, accounting revenue reached BRL 7 billion, a growth of 44.9% vis-a-vis 2022. The Fleury brand grew 9.9%. Other brands in Sao Paulo 38.3%, Rio de Janeiro brands with a growth of 23.2% and New Links with a growth of 75.6%. EBITDA Ex business combination onetime expenses reached BRL 1.6567 million with a margin of 25.6%. Net income totaled BRL 467 million. If we consider total expenses, one-time net income reached BRL 498.9 million, a 62% growth vis-a-vis 2022, with a margin of 7.7%.

We go on to the pro forma results, which is not audited. The gross revenue was BRL 1.8 billion, an increase of 5.1% growth, organic 4.7%. And of course, the seasonality of holidays and end of the year holidays, which means that we had less days to service customers. The growth was 6.5% for ex COVID. The Fleury brand grew 4.6% and other brands in Sao Paulo grew 10.3%. Home service grew 10.9% and 17.1% growth in New Links, 12% of which was organic growth.

EBITDA reached BRL 375.8 million with a 22.1% margin and net income totaled BRL 81.3 million with a margin of 4.6% and a growth of 61% vis-a-vis the same period last year. In 2023, the pro forma revenue reached BRL 7.7 billion, a growth of 9.7% vis-a-vis 2022. The Fleury brand grew 9.9%, Rio de Janeiro brands with a growth of 8.6%. Other brands in Sao Paulo growing 11.3% and New Links growing 75.6%. Our organic growth included 15 new units, 10 for diagnostic medicine and 5 for New Links. EBITDA reached BRL 1.8 million with a margin of 25.2% vis-a-vis margin of 51% pro forma for 2022.

This result shows the ability we have of preserving our cost benefit faced with an entrepreneurial pressure. We also had expansion in New Links. Now the expansion of the EBITDA margin shows our flexibility and resiliency and shows the continuous improvement of our operational efficiency.

I will now give the floor to Jose de Filippo, our CFO, who will speak in greater details of our financial performance.

[Jose de Almeida Filippo, executive]

Thank you, Jeane, and good morning to all of you. In Slide 13, we see that gross revenue reached BRL 1.8 billion, with a growth of 51% vis-a-vis 2022. If we discount the COVID test effect, the growth was 54.3%, with 21.7% of growth in home services, representing 7.1% of revenue. New Links had a growth of 17.1%, 12% of which was organic growth. In 2023, gross revenues reached BRL 7 billion with a growth of 44.9% vis-a-vis the previous year.

On Slide 14, we see that the pro forma gross revenue reached BRL 1.8 billion, growth of 5.1% vis-a-vis the previous year, 4.7% was organic growth. If we discount the effects of COVID test, the growth was 6.5% with an organic growth of 6.1%. The growth of home Services was 10.9% for the quarter representing 7.1% of revenue. New Links grew 17.1% with 12% organic growth. For the year, gross revenues reached BRL 7.7 billion with a growth of 9.7% vis-a-vis the previous year.

In Slide #15, as we have shown you in our last earnings results, the share of COVID exams in revenue had a drop compared to the previous year. In the fourth quarter '23, the contribution of these exams in revenues was 0.4% compared to 0.2% in the fourth quarter of '22. In the pro forma revenues, there was a drop in COVID exams, going from 1.7% in the fourth quarter '22 to 0.4% in the fourth quarter '23.

In the next Slide 16, we show you that the PSC gross revenues reached BRL 1.2 billion, a positive variation of 32.4% compared to the fourth quarter '22. A growth of 20.6% in Rio de Janeiro, 46.3% of other brands in Sao Paulo and a regional growth of 28.3%.

Once again, other brands in Sao Paulo had a growth of 46.3%. This is thanks to the strength of a+ brand and the mobile services. In 2023, accounting gross revenue reached BRL 4.9 billion representing a growth of 30.2% vis-a-vis the same period in '22. A growth of 23.2% in Rio de Janeiro, 26.4% of regional brands, the Fleury brand growing 9.9% and the Sao Paulo brands growing 38.3%.

In Slide #17, the pro forma growth shows us that the PSCs reached BRL [ 1.2 million ] in the fourth quarter '23, with an increase of 4.6% compared to the previous year. This reflects the growth of 4.6% of the Fleury brand although we had more holidays and less COVID exams, 10.3% of other brands in Sao Paulo with a highlight to the a+ brand and mobile services.

In the quarter, the brands in Rio de Janeiro had a growth of 1.7% and Minas Gerais had a growth of 6.3%. Regional brands had a growth above 0.5%, impacted by the comparison base of COVID exams and B2B regional brands. It would have been 5.5%. Otherwise, in 2023, gross revenues reached BRL 5.3 billion, a growth of 8.8% compared to the previous year. This reflects the growth of 9% (sic) [ 9.9% ] of the Fleury brands, 11.3% of other brands in Sao Paulo, 7% for the brands in Minas Gerais, and 8.6% in Rio de Janeiro. Regional brands had a growth of 4.9%. The growth would have been 7.6% without this classification.

On Slide 18, we see the accounting for New Links and health platforms, growth of 17% that reached BRL 168 million. The gross revenue reached BRL 154 million with a growth of 21% vis-a-vis the previous year. An organic growth of 12% in health platforms. The revenue reached an increase of 8.3%. For the year 2023, New Links and health platforms had a growth of 67.6%, reaching BRL 691.9 million. The gross revenue of New Links grew 75.6%, reaching BRL 640.5 million. Health platform had a gross revenue of BRL 51.4 million.

In the next slide, Slide 19, we present the pro forma results for New Links and health platforms. There was a growth of 16.3% in the fourth quarter '23 vis-a-vis the same period in '22 with BRL 168.2 million in revenue. During the year, the growth was 63.9%, vis-a-vis the same period last year, with gross revenues of BRL 693 million.

We go on to Slide 20, and we see that in the fourth quarter, '23 accounting gross profit reached BRL 400.6 million, a growth of 60.3% vis-a-vis the same period last year. The margin reached 23.5%. For the year 2023, net revenues was BRL 1.7 million, a growth of 43.8% vis-a-vis the same period in '22.

In the next slide, Slide 21, in the pro forma gross profit, we reached an increase of 4% growth vis-a-vis the last year. Gross margin was 23.5% with total revenues of BRL 400.6 million for the year. The revenues were BRL 1.9 million.

In the next slide, Slide #22, we show you that accounting operational expenses in the fourth quarter '23 were BRL 214.9 million, an increase of 51.8% vis-a-vis the same period last year, representing 12.6% of net revenue for the year. Accounting operational expenses reached BRL 758.5 million, an increase of 59.6%.

We go on to the last slide, #23. We have the pro forma operational expenses representing BRL 214.9 million in the fourth quarter of '23 equivalent to 12.6% of net revenue for the year 2023. There was a growth of 16.1%, reaching BRL 856.6 million, representing 11.9% of net revenue.

We go on to Slide 24. We see that accounting EBITDA for the fourth quarter '23 reached BRL 375.8 million, an increase of 61.5% compared to the fourth quarter '22, and a margin of 22.1%. For the year, accounting EBITDA reached BRL 1.6 million, an increase of BRL 39.2% vis-a-vis the results of 2022.

In the next Slide 25, we see that the pro forma EBITDA reached BRL 375.8 million for the quarter, a growth of 10.5% compared to 2022. For the year, EBITDA reached BRL 1.8 million, a growth of 9.9% and 25.2% EBITDA margin.

We go on to Slide 26. And in the fourth quarter '23, accounting net income grew 162.3%, with a margin of 4.8%, reaching BRL 81.3 million. For the year 2023, if we disconsider the onetime effect, the amount reached a growth of 51.7% compared to the last year, with a margin of 7.2%, reaching BRL 81.3 million. Now excluding the total effect of business combination expenses, net income was BRL 498.9 million, a growth of 62% and a 7.7% margin.

In the next slide 27, we can see the CapEx for the quarter, a growth of 15.5% compared to the fourth quarter of '22. Most of these investments were geared to IT and digital areas. Throughout the year, the investments reached BRL 413.8 million, maintaining the same level we had in 2022.

We continue on to Slide 28. Operating cash flow for the fourth quarter '23 reached BRL 423.9 million with a growth of 53.9% and conversion of 128% of EBITDA for the year. This operating cash flow reached BRL 1.4 million with a growth of 45.8% vis-a-vis the previous year. In the pro forma concept, this represented BRL 1.5 billion for the year.

We now go on to the next Slide #29, where we speak about leverage, you will see that it was 1.2x at the end of the quarter, maintaining itself stable vis-a-vis the previous quarter and the same period of 2022. Our leverage has been below 3x as part of the limit of financial covenants. This allows the company to resiliently face the increase in interest rates.

On Slide #30, we see the debt amortization schedule and the cash position of the Fleury Group. This shows you the solid cash position. We have a debt with a very healthy profile with an average term of 3.5 years.

And with this, we would like to go on to the question-and-answer session. I will return the floor to Jeane, so she can continue on with the presentation.

[Jeane Tsutsui, executive]

Thank you, Filippo. The results of the year 2023 shows that we're continuing with the trajectory of solidity and the delivery of results. It was a historical year. We held businesses with the Pardini Group that has always been a reference in medicine and with a regional and business complementarity.

This movement placed us among the healthcare leaders in Brazil, and we have maintained the principles underpinning our operations in recent years. We are a benchmark in the growth strategy, rigorous execution of our strategy, and we contribute to the sustainability of the healthcare system.

We are convinced that we are maintaining a positive trajectory with consistent operations in all of our segments. We have low leverage, sound financial position and Grupo Fleury is well positioned to continue on with a great deal of discipline.

And this is a moment that demands resiliency and an effective control of prices. On March 8, I would like to record my congratulations to all of our female employees, physicians. It's a day of celebration, of recognition, something that women have achieved, occupying all of these positions with merit. They have decided to devote themselves and [indiscernible] in these fields. Thank you very much and we are now at your entire disposal for questions and answers.

[Operator]

[Operator Instructions] The first question is for Mr. Boiati from Safra Bank.

[Ricardo Boiati, analyst]

The first question that I have refers to your top line growth. You gave us -- mentioned some very interesting remarks. In the fourth quarter, we see a slowdown of organic growth. Perhaps this is related to the calendar effect that seem to be more relevant for the Fleury brand because of the brand's positioning.

If you could perhaps expand a bit more on the market dynamic on the main markets where you have a footprint. And in the core, which is diagnosis, if there is a factor that has contributed to the slowdown that we see beginning with the fourth quarter and we already have gone through 2/3 of the first quarter, if you could perhaps give us more color regarding the beginning of this year and see if there is a dynamic that could justify a dynamic for a resumption of growth in the diagnostic vertical for the company. This is my first question.

My second question refers to cost, especially the synergy of cost and materials. Filippo, perhaps you could give us an update on what is happening with the capture of synergies. In this line item, specifically as it has already been implemented, what you still have to do the magnitude of this and additional details so we can better understand what is happening with the capture of synergies. These are all my questions.

[Jeane Tsutsui, executive]

Thank you, Boiati, for the questions. Regarding the top line growth, we had seasonality in the fourth quarter, very similar to what we saw before the COVID pandemic. We had a very positive year with pro forma growth of 9.7%. And in the last quarter, the fourth quarter, we had more holidays, the impact of the end of the year that we had seen in years before the pandemic. This led to a growth of the top line by 5.1%. Regarding the brands, this impact was greater in the Fleury brand that is a premium brand and is more impacted by these holidays. We have information from the retail market that was also impacted because of the length of these holidays.

In other brands, we had healthy growth. The Fleury brand had a growth of 9.9% throughout the year, which is very important. The Rio de Janeiro brands in pro forma grew 8.6%. In the fourth quarter, there was also an impact in the other brands with a highlight for a+ in Sao Paulo.

So once again, we can't give you guidance. But in the first quarter, what we see is within our expectations. The year 2024 should be a positive year. We are ready for it. We should have a greater growth of volume, and we have underscored this. We have been able to grow with more volume, maintaining very healthy margins.

We have a first half of the year that points to a margin expansion. Regarding cost, I will give the floor to Filippo to speak about our synergies and the cost of material.

[Jose de Almeida Filippo, executive]

Boiati, when it comes to the cost of materials, this has already appeared in former quarters. This refers to the growth of infusions that is part of New Links. The cost of material because of the drugs tends to gain greater relevance. And this is characteristic of the activity per se, and it begins to appear because New Links has grown and infusions play an important role in this.

We have always presented this information, and we include the growth of New Links as part of our revenues of the year. This is something that we have mentioned and we have mix

changes that also impact the revenues and increase the cost. When we speak about synergy, the integration program with Hermes Pardini is the main program we have. There are groups of initiatives that we follow on periodically. There are weekly meetings with management for a follow-up to detect signs of warning. So the accountability here is very important.

At this point in time, we are revalidating the goal. In 3 years, we should have BRL 200 million to BRL 230 million in synergy. This is the official guidance, which we are maintaining. The integration is underway. And once the integration is full, these synergies, of course, will be obtained. We brought in-house some of the exams that were being carried out by third parties. Because of this combination, we are optimizing logistics for both brands. Working in combination, we are collecting toxicological exams at Fleury units and a+, for example, without taking into account that we're already offering in the lab-to-lab portfolio exams that Fleury had but Hermes Pardini did not. So the integration is making strides. There is an enormous concern with cultural issues.

We're following up with the mood of the people because this is very important to reach our goals. In general, the program is making strides as expected and we are revalidating our goal when it comes to attaining synergies.

[Operator]

The next question is from Rafael Barros from XP.

[Rafael Junqueira de Barros, analyst]

In truth, I have two very short questions. The first refers to investments and expansion. When we look going forward and see what you intend to invest in expansion, how would you qualitatively divide these investments in M&As and organic growth? There are several growth opportunities for organic growth. That is the first question.

The second question refers to your working capital. The sector is under some stress and there is the pressure of operators on all of the service renders because of the longer payment terms. But we have also seen that you had a better payment term dynamic during the quarter. Do you think that there is room to enhance your working capital when it comes to receivables and payables in the year 2024? Do you think this will materialize?

[Jose de Almeida Filippo, executive]

Well, thank you, Rafael. Let's begin with the part of expansion. You were speaking about M&As, whether inorganic or organic. Of course, we consider options for the growth of the company, and this will always be our vision in the long term. A combination of both models. We do not have that ability to control opportunities, especially for inorganic growth.

Some years ago, the inorganic component was more intense because of the opportunities we faced and the discussion of the value of assets and our ability to comply with our economic and financial indicators. More recently, beginning last year, we saw a greater organic growth.

We carried out expansions not only in New Links, but also in diagnostic medicine. Because although we have maintained our activity and the prospection of assets and the management of the M&A pipeline, we have an active M&A team. In truth, we have not been able to materialize this because we have a financial discipline. We have to have indicators for return and the price expected from sellers, of course, has not allowed us to have a great evolution. So these are moments when these mortalities tend to oscillate.

Last year, we had a greater organic growth. We're looking forward, and we believe growth will come from both areas. And of course, we're never going to put aside our financial discipline and compliance with our indicators when doing this. Now when we speak about working capital, we carry out a very intense management. You will see that our cash growth has been intense, and this is because of our discipline in working capital.

We have little variation in accounts receivable, something more associated to the business combination of Hermes Pardini and Fleury. But in truth, we have very close commercial proximity, enabling us to have a good follow-up in accounts payable. Suppliers are an important item here. We work very closely with them. We ensure that we have balance so as not to pressure the working capital.

We spoke about mergers. This tends to increase inventories -- infusions, I'm sorry. We have a higher inventory. This enables us to leverage our capacity for procurement. So there are factors associated to that. In general, of course, we have not increased our working capital. It does reflect the growth of the company itself, but we're working very closely in this. [indiscernible].

[Mauricio Cepeda, analyst]

Can you hear us?

[Jose de Almeida Filippo, executive]

We cannot hear you. I'm afraid, yes, that the answer was not full.

[Operator]

Very well, we were not able to hear the entire answer. Cepeda,if you would please repeat your question. We had a slight instability in the line.

[Mauricio Cepeda, analyst]

And I think the audience did not hear the full responses, but I will pose my question. On our part, we have two questions.

The first referring to the potential for future growth. We see that you have had a strong growth in volume, and this has been reiterated in the past, and this offsets the reduction in the average ticket. This occurs in B2C as well as in B2B. Well, the growth in volume is quite clear.

Now until when do you see that this growth in volume will be possible because the beneficiaries in the system are not growing very much. The plants are not growing very much. How long do you have to gain share to expand organically or create more restrictive groups?

This regarding growth by volume. I mentioned the ticket, let's speak about ticket. We know that the average ticket is brought down because of the mix. You have carried out more clinical analysis as part of your commercial strategy. But when will this mix become more stable? You have a highly diversified business. And when should this mix become more stable?

[Jeane Tsutsui, executive]

Well, thank you, Cepeda, for the questions. I will begin with volume. I think you observed properly. And every year, we have a greater growth in volume. Therefore, growth in exams and constantly a gross revenue per exam that is somewhat lower. Once again, this is due to the mix effect. We have carried more clinical analysis. This will increase the exams per customer, a reduction of revenue per exam and this mix is very important. But generally, we have also had a growth in all of the business lines, bringing about greater volume. And this is interesting because it enables us to dilute fixed costs.

And we have a productivity discipline that will lead us to having a healthy margin in all businesses. We have some levers such as lab-to-lab or mobile services that bring in more clinical exams with a very healthy result, and we do foresee opportunities to continue to grow in the year 2024 organically with the growth of volume, gaining in productivity and bringing in [indiscernible] balance. We know that there will be a mix between the mix of brands, the mix of services and capture of services as described by Filippo.

So very generally, our vision is that we still have opportunities to bring in greater volume. The mobile services are levers that grow quarter-on-quarter. We have penetration levels of mobile services compared to PSC that is still heterogeneous. Mobile began with a greater penetration and other brands, including the Pardini brand, with more space to grow. So we still have the opportunity to continue growing based on volume, which is important for us to gain productivity.

And through time, we also detect the opportunity for other types of growth. When we speak about ticket, it is that mix effect once again. When we compare the same mix, we are maintaining the ticket. The effect is what takes to the reduction, Cepeda. This is a very general view. And I remind you that in 2023, we had a growth of 15.1% in volume in the pro forma accounting with a growth of 9.7% in revenue.

We have a higher share of the B2B segment, especially in lab-to-lab, and we have a greater share in the New Links. So this balance, if we look at our strategy of ever more having the 4 avenues for growth expanding. And if we enhance the care journey, lot of this will be very relevant.

We have that need to work closely with the operators offering solutions for this specific moment where we know that the claims are still quite high. So in our vision, we do have that opportunity of working very closely with labs, offering support, work closely with operators, bringing in more revenues for our operations.

[Operator]

The next question is from Joseph Giordano from JPMorgan.

[Joseph Giordano, analyst]

I would like to explore a point mentioned by Jeane that refers to the payers. We look at the cash cycle of the company, and we see accounts receivable deteriorating. Even when we look at the pro forma metrics, there is a difference of 7 days regarding payment. I would like to explore 2 points with you.

Shouldn't there be a normalization of this during the year. because the B2C grows more than B2B. There were also changes due to contractual situations with hospitals, for example. So which would be the trajectory of these receivables?

And secondly, to speak about negotiations going forward, we refer to the issue of tickets versus mix. How do you foresee the transfers throughout the year? And there have been some taxation changes in ICMS. Will this have an impact in terms of cost when you purchase inputs?

[Jeane Tsutsui, executive]

Thank you. Joseph, for your questions. First of all, regarding our positioning with operators and negotiations. Throughout time, we have sat at the table, listened to them and attempted to offer solutions to all of the links in the chain, especially when it comes to the source of payments. The positioning of the Fleury Group is to look at prevention, early diagnosis, offering integrated services with New Links and outpatient services. All of these are geared to contribute towards the sustainability of the system. This is a stance that we have taken on and that we will maintain.

In terms of the average term to receive payments, the figures that we present refer to the accounting part, which means to say we have an increase in the fourth quarter and the year of 9 days in average term of receivables, 3 days of payment. This in the combined companies, I remind you that we have a mix of B2B, lab-to-lab that has a somewhat different profile from what used to be the Fleury Group, where this term was 65 days. And in the fourth quarter, the combined company reached 74 days.

Now this different profile takes into account the dynamic of the different businesses. The Pardini Group has a somewhat longer term than ours previously for services like lab-to-lab, where we invoiced to the laboratory and the laboratory will invoice to the source of payment. We're very attentive to this process to attempt -- to improve this indicator through time.

And we are also, when it comes to forthcoming negotiations, holding conversations very generally, Joseph, what we can say is that we have brought in more contracts where we will grow more based on volume instead of risk. And we have a dynamic of inflation. We always say that we transfer part of the inflation. And we now have an inflation that will decrease. So the price component will be somewhat lower compared to situations with high inflation.

On the other hand, we have that component of volume that continues to grow. And we have gained efficiency with an increase in productivity. And it is important to maintain sound margins for the different businesses. This is the dynamic that we have undergone and what we foresee for the future. Regarding the taxation issue, Filippo will answer the question.

[Jose de Almeida Filippo, executive]

Well, there was a change in taxation, the ICMS. We do not anticipate an impact on taxation, not on ICMS or in broader aspects. The taxation reform has become more detailed and we have no expectation for change or impact on our financial systems.

[Operator]

The next question is from Vinicius Figueiredo from Itau.

[Vinicius Figueiredo, analyst]

First of all, I would like to explore the behavior of your margins, given that we have a component in the fourth quarter that became more evident showing that the Fleury brand is slowing down more than the others. I am curious in terms of how this mix effect could impact the margins of the company in 2024? And if throughout 2023, by analyzing operation by operations, brand by brand, separating B2B, if had a margin expanding? If there's still room for this in 2024?

And the second point I would like to remark on refers to SG&A. I know there is a seasonal component here and the fourth quarter ends up having a greater impact. But I would like to understand if there is a bonus linked to [indiscernible] a closing for Pardini? Or is it simply that seasonal component?

[Jeane Tsutsui, executive]

Well, thank you, Vinicius, for the questions. The Fleury brand grew less in the fourth quarter, as you mentioned, and we had a+ plus in Sao Paulo with robust growth. We have spoken about the market share. Grupo Fleury is a mature brand with a very high market share. We have maintained that market share in the fourth quarter. So it's more the effect of seasonality and our vision. The a+ brand that has a lower market share continues on with very robust sound growth. Now through time, we have observed this effect of the mix of brands in our business.

We are a company with different brands, premium, intermediate and basic. And the combination of businesses with Pardini has strengthened our mix of brands, our regional expansion.

The profitability of the different brands has been maintained. And through time, we will work so that different businesses will have ever sounder margins because of productivity. [indiscernible].

[Vinicius Figueiredo, analyst]

I was not able to hear you.

[Jeane Tsutsui, executive]

We apologize Vinicius. Can you hear us.

[Vinicius Figueiredo, analyst]

Yes. I do hear you now.

[Jeane Tsutsui, executive]

I was mentioning the mix of businesses and the mix of brands. And the great example, our New Links. They grew 75% for the year, 17% from the quarter and New Links structurally has a lower margin because it refers to other services, infusion of drugs, consultations, physical, [indiscernible] different profile. When we look at this combination, the margin of the different brands and businesses, they are stable. They tend to enhance productivity.

On the other hand, the mix of brands and businesses will change. What is more important is that we know that we're going to dilute fixed costs, increase productivity and capture synergies in such a way that we were able to deliver in the third and fourth quarter on margin expansion, maintaining a healthy EBITDA margin similar to the pro forma in 2022.

The year 2022 and the first quarter was benefited by a wave of COVID that increased the margins. But we always said that we would maintain margins in 2023, and this is what we delivered. Now to go to your questions, the margins of the different businesses, we work towards gaining efficiency. The margin mix will be somewhat different and this is our strategy.

It protects, it guarantees greater growth for the company, and we're very attentive when it comes to return on invested capital. So this healthy balance of organic growth or inorganic growth, a healthy margin of the different businesses that do have different margins and return on invested capital. We will make sure that this combination will be very healthy.

Regarding G&A, more specifically, we know that there are seasonal variations. But generally, I draw the attention that we have reduced SG&A when we compare quarter-on-quarter in pro forma for 2022 and 2023. This is due to the capture of synergies. We do have complementary operations.

We have less room in the operations because we have PSCs and technical areas that are complementary. Services are complementary, but we have worked towards capturing synergies in that field.

[Operator]

The next question is from Gustavo from Bank of America.

[Unknown Analyst]

I would like to explore New Links, speak about margin expansion during 2024 and the top line growth of New Links, they grew 12% this year. The growth outlook is above what was diagnosed, but how can we think about this going forward? Will it continue on that base of 12%? And the second question is regarding CapEx for 2024.

It was stable in 2022, 2023. What is your expectation for CapEx in 2024 and which was the CapEx at the end of the quarter simply so that we have an idea of what happens?

[Jeane Tsutsui, executive]

Thank you, Gustavo. Regarding New Links, to reinforce the figures in the fourth quarter, we had a growth of 17%, a 12% organic growth. During the year, the growth of New Links was 75%. We did bring in some acquisitions.

SAHA, that is an asset for immunobiological infusion contributed to this, and [indiscernible] had the Retina Clinic for ophthalmology, a small clinic. So New Links represents 8% of the total revenue and it shows a robust growth. This avenue was structured since 2021 as a growth avenue per se. Our outlook is that this is a very robust avenue. We do have priorities. We prioritize some specialties that have different levels of maturities.

We carried out acquisitions like CIP for medication, the Moacir Cunha eye clinic, but we are on a trajectory for organic expansion so much so that this year, we opened 5 new units for New Links, and we have explored new products within the existing units. So our outlook for New Links, and you know that we don't offer guidance, is to continue on in this trajectory as a good avenue for growth, something that will reinforce our strategy, our positioning in terms of the offer of solutions to operators integrated with the customer journey.

New Links is still there and in terms of percentages, it will tend to have a greater footfall. Now regarding the margins, we see that New Links has a different structure. They have a structurally lower margin, but as soon as they obtain a greater size, we will be able to increase and expand the margins of these new services. They will not reach the same margins of diagnostic medicine as we're dealing with different structures. But in terms of return on invested capital, the return is very healthy.

And this is what we look at. We're quite confident when it comes to this avenue for growth. It is complementary to our services and reinforces our strategic positioning. I will give the floor to Filippo to answer the question about CapEx.

[Jose de Almeida Filippo, executive]

When we speak about CapEx, if we analyze the last quarter, we had a growth vis-a-vis the previous year. But you know that investments tend to oscillate quarter-on-quarter. And it's easier to look at the full year. Our CapEx profile has been maintained. Half of the CapEx is associated to IT and digital enhancements in our program for systems, speeding up the digitation and all of that part of the connection of the different systems we have. We have spoken at length about this. There is a demand, and this is a very important point for us.

The other half is distributed between the renewal of equipment and the expansion of units through retrofit, the expansion of area or new units, we did have a few last year. So this profile should be maintained. When we look at the full amount, the year 2022, the figure that we showed you did not include Pardini, but it included the technological center.

In 2023, it began to have the contribution of Pardini, a slight carryover of the previous year, and the CapEx are very similar. Now this is a line item that we work with very carefully in terms of prioritization, cash is valuable, liquidity, maintaining our leverage. All of this is part of our strategy of discipline, to look at these figures without putting at risk the capacity of the company. Looking forward, we don't have a guidance for this, but there will not be a significant change of this profile. This is how we are thinking about our CapEx strategy for 2024.

[Operator]

The next question is from an [indiscernible] from BTG.

[Unknown Analyst]

I have only one question. A question that is a little out of the box. Considering that Fleury is always at the forefront in terms of options and technology, would like to understand how AI could change this segment, if you're testing and using this in some of your positions?

[Joseph Giordano, analyst]

First of all, we truly are a company that value science, technology and innovation. In 2023, we launched 500 new products and services, which shows that we're always at the forefront with genomic tests, diagnostic tests and new services. In technology, we have invested to enhance the experience and digital evolution.

And speaking specifically about artificial intelligence, we're working with technologies that are applied in diagnostic medicine and in the health field in general. I will give you some practical examples of what we have done with AI. We have already incorporated into our magnetic resonance equipment, deep learning techniques that increase productivity. In these specific cases of magnetic resonance, there is an increase of up to 48% in the processing capacity, which means we reduce the time to acquire images. Well, simultaneously, we have an improved quality.

We have applied AI in several other areas, be these areas that relate to genomics, several genomic tests at present have AI technology or we have explored applications of generative AI for other ways of capturing an increase in productivity whilst also enhancing the customer experience.

If we look towards the future in medicine and health, of course, there will be several applications, always been very cautious with the regulatory issues. We have a group that carries out analysis so that we can use it more, but in a highly controlled fashion, following up closely on the results.

[Operator]

The next question is from Emerson Vieira from Goldman Sachs.

[Emerson Vieira, analyst]

I have three questions here. The first question is to explore the top line. You spoke about the boom of growth in 2024 that will be based on volume. Which are the main reasons for this? Is it because you're expanding the offered exams, acquisition of new contracts or the expansion of mobile services? If you could refer to more details on this.

Secondly, capital allocation, one more quarter of a very robust capital allocation. Now looking at the M&As, which is the type of assets that would make more sense for you? Diagnostic medicine, New Links or other markets like oncology as an example. That is my second question.

The third question refers to the cost dynamic for materials, non-oncologic materials. That has grown significantly in the company. It has gained scale. So which are the conditions for the procurement of material for infusions, for example, do you see a gain because of the increase in scale in those lines? And if the pressure for this should be reduced as you gain scale in infusions, for example.

[Jeane Tsutsui, executive]

Thank you, Emerson, for the questions. Regarding the top line, there is an opportunity for growth based on volume. Because of some components, we have gained market share in some brands. The example is a+ in Sao Paulo. We had a lower market share, but we have followed up on the gain of market share in Rio as well.

The number of lives doesn't grow, but we are growing based on volume. Now there is a potential for new contracts. We are constantly holding commercial negotiations. And what is important in this combination of business is that we have an entire area with a commercial director that is holding conversations. We have some closer to operators with the opportunity of bringing in new contracts, expansion of the mobile services is still possible.

Mobile services brings in clinical exams and the trend is to bring in more exams per patient and we have different levels of penetration of mobile services if we look at the different brands. And these are the opportunities we're looking for. In terms of capital allocation, we have been very diligent. Filippo spoke about our assessment process. We ended 2023 with BRL 411 million in CapEx.

We have been very diligent. And of course, we're expecting a return on this allocation. We have a great deal of discipline in M&A. We always assess the M&A pipeline. What we have in the pipelines are diagnostic medicine assets in areas where we still do not have a footprint, where we could capture synergies after the integration. But as we mentioned, in any M&A, we think about strategic issues, cultural issues and in a very disciplined way, the financial parameters.

Emerson, it could be M&As for New Links. In New Links, we had a stage of acquisitions. But we also have the opportunity for organic growth. We don't put aside the possibility of M&As in New Links. We have joint ventures with some hospitals and any M&A in oncology will be done through a joint venture. Regarding the cost of materials, we have grown with the infusion of immunobiological drugs.

Once we have a greater volume, we can negotiate price better. Now the profile, the structure of this business is different. The drug component -- well, the drugs have a steep cost and the cost structure is quite significant. Once we have a greater volume, of course, we can hold better negotiations. And this is what we are doing. But I remind you that the cost structure is different with a very high cost component. In the medium and long term, our outlook is to be able to capture these synergies between the businesses at New Links.

[Operator]

The next question is from Leandro Bastos from Citi.

[Leandro Bastos, analyst]

Simply one question at my end. If you could speak about how you foresee the evolution of your premium plans in the Fleury brand? Have you seen a fluctuation in these contracts?

[Jeane Tsutsui, executive]

Very clearly, we don't see great differences, Leandro. If we look at the number of beneficiaries in supplementary health that ended the year at a bit more than 50 million. Yes, it is clear that we have greater growth in the basic segment, at the base of the pyramid, which is natural. We did see a growth in the year 2023 vis-a-vis 2022.

This growth is greater in the base segment. The premium segment, we tend to say it is resilient in general, but it tends to grow less. Because of the positioning, we do not foresee significant changes in our market share here. What we do have, Leandro, is a dynamic of customers with access to our brands. We have worked on this to bring in more customers with access to our brand.

This is what we call total addressable market, TAM, and this is what we're going to work on. When we look at the PSC component, we have more brands positioned now in the intermediate and basic segments. These are segments where we have the strategy to enhance access to our brands throughout the country. We have more than 500 PSCs in 13 states and these is plurality of brands, our positioning, and greater diversification of sources of payment [indiscernible] interesting strategy for our growth going forward.

We used to say that we had 90% of revenue coming from operators in the past. This has decreased because of the business combination with Pardini and the lab-to-lab component. This diversification is very interesting for our growth.

[Operator]

Ladies and gentlemen, at this point, we would like to conclude the question-and-answer session. I will return the floor to Ms. Jeane Tsutsui for the final remarks.

[Jeane Tsutsui, executive]

Thank you all for your attendance today in the fourth quarter '23 conference call. And the year 2023 was historical. We reinforced our strategic positioning with a strong execution discipline and marked by a combination of business between Grupo Fleury and the Pardini Group. We are at your disposal should you have any questions. And we hope to see you in the release for the first quarter of 2024. I once again congratulate all the women in our operations, our customers that are women and all women in society. Thank you very much.

[Operator]

The Grupo Fleury conference call ends here. We would like to thank all of you for your participation. Have a good day, and you can disconnect.